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General NPI Number Information
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NPI Number | 1740645357
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Entity Type | Organization
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Legal Business Name | JACK LOMANO MD
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Dates
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Enumeration Date | 12/24/2015
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Last Update Date | 12/24/2015
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Provider Practice Location Address
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Address Line | 15644 CALOOSA CREEK CIR
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City | FORT MYERS
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State | FL
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Zip | 33908-6736
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Country | US
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Telephone | 239-470-8809
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Fax | 239-236-3900
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Provider Business Mailing Address
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Address Line | 15644 CALOOSA CREEK CIR
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City | FORT MYERS
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State | FL
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Zip | 33908-6736
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Country | US
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Telephone | 239-470-8809
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Fax | 239-236-3900
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JACK M LOMANO
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Credential | MD
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Telephone | 239-470-8809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME33323
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License Number State | FL
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